I’m not going to write this from a research perspective, quoting percentages based off recent studies. I’ve discovered that nowadays you can find causative information to suit your opinion, whatever that may be, based on a plethora of info readily available to anyone well-versed at Google. So instead I’m just going to speak my thoughts from experience. My personal experience as a Registered Nurse in the ICU setting.

So recently I looked over at a physician I have worked closely with for over half a decade and asked, “do you think as a whole the patients are getting sicker?”

It didn’t take him long to agree emphatically, “they sure are!”

I’ve been in the healthcare field for roughly 21 years, and I’ve been a critical care nurse for the last 14 or so. As long as I’ve been a nurse there’s been plenty of “business” to keep us busy, but I’ve seen a big shift in just the last one to two years. It seems like our patient population is becoming more and more critical. The patients are getting sicker. Where you used to have “slow” days occasionally, now that never happens. I can recall getting a high number of people in the ICU who perhaps didn’t require close monitoring, or maybe they weren’t as ill as they initially presented in the ER. They were easily stabilized, and not much blew my skirt up. That’s changing.

Over the last year it’s become abundantly clear. I can pretty much bet that when I come in I’m going to run my legs off, my adrenaline is going to be pumping the entire shift, and we’ll probably code someone at some point. I’m seeing sicker and sicker people, of all races and ages, and the older I get the younger my patients are getting. It’s not uncommon for me to see multiple patients in their thirties in a week’s time, and these are hospitalizations not brought on by simply trauma like you may think.

So what’s causing the shift? My first thought was the baby boomers. They’re getting older, and now the largest portion of the population is getting sick and hospitalized. They were warning of this back when I was in nursing school, and it’s certainly come to pass. So, yeah, I think that’s a large contributor, but I don’t believe it ends there.

I feel like we’ve certainly gotten better at what we do in the healthcare field, and people that would have died 25 years ago are now living longer to be a patient another day. Our technology and knowledgeable skills are definitely keeping people alive much longer, leading to a higher acuity population as years go by, but also the rising cost of healthcare and health insurance keeps many people from utilizing preventative care. This means many people’s first experience with healthcare is when they end up emergently in my unit. Sad, but true.

But then there’s this little nugget. We are paying for our own pleasures. We exist in a fast paced world. It’s one where answers are at our fingertips, but we’re usually too impatient to even wait that long. We’re a generation that has plenty, but desires more. Enough is never enough. We’re a people who have a calendar, alarm, and reminder notifications on our handheld cell phone, but it doesn’t save us an ounce of time. We rush to and fro, we over-schedule, over-commit, and overdo everything. We are stressed to the max, more-so than any generation before us, in my opinion, and though we know more easily how to care for ourselves, we do not. There’s no time for that. I wonder if we’re getting sicker in part because we so desire to be invincible?

We overeat, eat the wrong things, and skip out on annual checkups. We pay too much attention to what others think of us in this world, and not enough on taking care of ourselves. We are a people who cannot be still, and more than anything we’re lacking rest. Both physically and emotionally. Anxiety and depression levels are through the roof! We can find the local Starbucks, yet we can’t find peace.

There is so much in this world that we cannot control, so many stressors, and we have become a generation that desires control of all the things. It’s crippling. And while we cannot control the world, there are many aspects of our life that we can reel in. These aspects can have a positive impact on our health, I believe. We can slow down. We can stop thinking everything is a must. We can stop putting too high of expectations on ourselves and our loved ones. We can stop trying to be the best at all the things, and just be still.

We can pay attention to our health and our bodies more. I can’t control the rising cost of healthcare, but I can try and eat better, exercise, and get my cholesterol checked. If you don’t like your job you can find something different. You can take a pay cut if you have to. I’d rather downsize my house on my own accord than have to later after a major illness and hospital course forces me to do so. You don’t have to keep up with The Joneses. You just have to keep up with yourself.

In short, we are getting sicker. I can see it. And while there are many factors at play in this, there are only so many aspects that we can even do anything about. But we gotta do something about the things we can manage to alter. We can pay less attention to our mounting to-do list of seemingly important issues, and pay more attention to our personal health. We can eat better, visit the doctor’s office, keep risk factors in check, and listen to the advice of healthcare providers. We can seek help with stress relief and mental well-being. We can make a point to rest more, emotionally and physically.

My husband walked in the door with a smile after having taken our middle child to an appointment, and I was just turning off the water at the kitchen sink. As it made a gurgling sound going down the drain I dried my hands on a striped towel and deposited a kiss on my husband’s lips.

“Hey babe!” I said, then I leaned against the counter nonchalant.

He walked into the tidy living room to lay down his phone, but quickly returned with incredulous eyes.

“How did you get so much done with the baby here?” He asked in surprise. “Has she been upstairs this whole time?”

I heard the tiny feet overhead that sounded like a trampling elephant.

“No,” I answered. “She just now went up there.”

Then I proceeded to share how I had given her and her sister a bath, dressed her, and fed them. I explained about kissing booboos and giving attention while also loading the washing machine and dishwasher.

“I guess I’m just good at multitasking,” I answered.

He nodded agreement, but his facial expression still radiated awe.

I smiled satisfied.

There’s a lot of things I feel like I’m pretty good at. I feel like I’m an above average nurse for my patients, and I like to think I’m a good friend and sister when people need me. I’m a decent writer, and I even learned I have some valuable leadership skills when I started my own business a couple of years ago. Despite feeling many days like I’m a failure at motherhood, when my kids run to me excitedly with love in their eyes after I get home from work, I realize I’m a good mom. My husband tells me I’m a great wife, and his silence as he scarfs down supper tells me I’m a skilled cook. Of all the many hats I wear I realize one thing holds them all in harmony. My superhero strength of multitasking. All women have it, I think. It’s like it’s coded specifically into our DNA.

Recently my husband has been able to spend more time home with our children. He’s gotten more involved in their homeschooling and the day-to-day business that is running a house. I think he’s always known my job at home was a full one, but I’m not sure he realized just how difficult it can be to get it all done. The fact is, you don’t. You just do what you can. Recently I was at work at the hospital and I received a text from him.

I will do my best to fill your shoes around here today, but you may have to bear with me since it’s kind of new to me still. You are my best friend, lover, and partner in this wonderful life God has given us and I just want you to know you are very appreciated by me 😘

His words proved to me that he saw me, he saw how hard I worked around the house, and he acknowledged that he couldn’t do it like me. So many times women want to be able to do all the things that men can do, but in that they lose sight of all the things they can do that men cannot. Women have unique talents that set them apart, multitasking being a big one. We are usually, natural nurturers, and we hold a compassion level and emotional connection with others that cannot be compared. We see problems and the world around us from a wise and distinctive perspective, and we’re typically excellent planners and solvers. For me, it’s nice to be able to work outside of the home, but it’s also wonderful to be appreciated for the work I do at home. I’m blessed my husband sees my success in both arenas.

He may not ever be able to multitask around the home like I do, and that’s ok. I wouldn’t want him to be like me because then he wouldn’t be the special man he is. Some things women just do better than men, and it’s ok to be proud of that. We as women should be proud of who we are as human beings. We are definitely fearfully and wonderfully made!

I lay down on the couch cuddled with my toddler as she watched Paw Patrol, and I could hear my other daughters giggling loudly in the bathtub. I would need to help them wash their hair shortly, but for now I just enjoyed laying there. I pulled the comfy throw blanket up around my shoulder. We still had homeschool lessons ahead, but for now I snuggled deeper into the sofa savoring the way the cushions caressed my weary body. I was so tired! Why? I had gotten a great night’s sleep. My eyes even burned, though, as if I hadn’t slept a wink, and then it hit me why.

Yesterday I remember at one point feeling a pain in my chest. I knew what it was right away. I suffered from some pretty intense acid reflux (for which I was medicated), and the burning feeling in my lower esophagus was definitely the familiar pain of a flare up of my Gerd. I wished for Tums. Then I also realized it was likely an empty stomach causing me discomfort, with nothing on it to neutralize the stomach acid.

I had looked at my watch. Almost 2pm and no lunch yet. I could have asked for someone to relieve me, and I even knew there was a plethora of snacks in the break room at my disposal provided by our administrators. But I couldn’t make myself walk away. I was invested. I was deeply invested in the outcome of my patient, and I just didn’t feel like I could walk away until the patient was more stable.

I had looked at my watch. Seven hours. Seven hours had gone by with me on high alert, at a point of performance far beyond that of an average day. Due to the seriousness of the situation and the intensity of my critical patient, my senses had been in overdrive since I arrived. My heart beat a little faster, my brain functioned a little quicker, working to anticipate the next change. It was like being on a roller coaster. For seven hours straight. I could feel the adrenaline still pumping and I wondered briefly, “how long exactly can one go at this pace? You gotta step it down a notch, Brie. You’re gonna fizzle out.”

I took a deep breath, working to mentally and physically slow my senses that seemed more alert and expectant than usual. Then something else intense required my quick thinking and action, and I was right back at it.

It wasn’t all bad. It felt good to do good. It felt rewarding to fix things, to explain alarms to family, to answer questions and ease fears. It was wonderful to see the low blood pressure come up, to watch the high heart rate come down, and to obtain the orders I needed from the physician to make those things happen. It was an honor to be a part of life-saving healthcare, in the trenches of serious situations, catching minute changes before they became a more serious issue, but it was also immensely intense.

At some point between four and five o’clock I looked at my watch again and thought with relief, “just three more hours. I only have three more hours I still have to keep this patient alive until I pass the torch to the next shift. I can do that!”

That may sound awful to anyone who hasn’t been in that situation. It’s not meant to be. It’s just that when you’re on overdrive you can only keep going so long.

When I had gotten home, feeling tired yet satisfied, I had bragged to my husband about how cool I was. “Aren’t you proud to be married to someone who saves lives for a living? Is it hard being in love with an angel who wears scrubs?!”

He knew I was just joking. Because that’s how you had to look at it sometimes. You could either say, “oh my gosh, I’m exhausted, that was the most intense, awful day ever,” or you could say, “oh my gosh, I’m beat, but I got to be a part of something intense and amazing today.” Everyone deserved a chance to live another day, and if I had any small part in keeping things headed in that direction then it was a good day.

But as I lay on the couch this morning I realized that the intensity of the day before had caught up with me. I’ve never ran marathons, but I would imagine it’s a little bit like that. Sometimes work is like a race, and you don’t stop running until the finish line. You don’t slow down, you don’t give up, and you keep your eyes on the prize. But the next day off you’re grateful for ice water, Motrin, and rest.

She was gurgling. Oh God, she was gurgling as she breathed, and my heart was certainly beating even faster than the high rate I saw displayed on her bedside monitor. I grabbed shakily for the Yankauer suction above her bed. I knew that’s what it was called. I was in my first semester of nursing school, so I knew what the suction was for, but I hadn’t actually used one on a real person before.

My mother didn’t look like a real person at all. Laying there in the bed, swollen, bruised, with about a billion lines and tubes running from her. She had been flown to this trauma ICU bed after a horrific car crash, and being in the best hospital in the area should have given me peace, but it didn’t. The truth was I was scared to death, scared I was gonna lose my momma, and despite me sticking that suction thing half-heartedly into her mouth, she was still making a sound like she was breathing through water. I hit the call button frantically.

Where was the nurse?!! I wondered. Couldn’t she see this was not a good situation? Shouldn’t someone be stationed right here at her side until she could at least open her own eyes and ask for help? Why was it taking so long?!! Why wasn’t the nurse coming?!!

Fast forward twenty years and now I’m that nurse. I’m the one who wants to be at your momma’s bedside, but who also has someone’s father, husband, and son in the other ICU room. I’m the one who is limited by space and time in my physical body, but who more times than not, wishes I wasn’t.

Here’s what you may not realize as a concerned family member.

I am concerned too. Your family member is also important to me. They’re more than a patient number. They’re a human being who is loved. I have been the daughter at the bedside, and one day, as my husband and I age, I realize I may be the concerned wife also.

I don’t want you to wait. Seriously. I really don’t. I want to attend to your need as quickly as possible, but when you don’t see me I am attending to another patient’s need at that time. Another important, unique, loved family member who occupies another bed. Or perhaps I am even tending to myself. Trust me when I say you want a nurse with a full belly and empty bladder. We can focus so much better in that condition.

I know that being sick is difficult, and I know that watching someone you love fall ill is even harder sometimes. I understand that emotions are raw, nerves are frayed, and angry words come easy in such a stressful, uncertain environment. That doesn’t mean I don’t get hurt feelings or frustrated occasionally, but it does mean I try my best not to because I truly sympathize and empathize with each patient and family member. Those are the things you cannot see under the surface of my calm, efficient manner.

When the nurse finally arrived to my mother’s bedside she quickly took the suction from my hand. She seemed so blasé, as if she was not concerned at all. She went about quickly settling my mother down, and then just as quickly left the room. I wasn’t sure what to think at the time, although I was grateful that my mother seemed to be breathing easier. Looking back I realize I didn’t know that important oxygen readings were being transmitted to a monitor outside the room so they could know immediately if my mother was in respiratory distress.

I didn’t realize at the time that what may have been concerning and scary for me was a natural and expected presentation in a critical care setting. I took the nurse’s demeanor as indifference when it was in fact an attitude of efficient knowledge and calm clarity to act on my mom’s best interest.

I didn’t take into account other patients. I only saw my mother. I didn’t see someone else’s mother in the very next room. And that’s ok; it’s human nature. Even today if one of my children found themselves in the hospital, my mommy heart would feel they were the patient needing the most attention at that moment. The thing is, nurses feel the same about their patients. To nurses, each patient is important and deserving of our care, but it’s our difficult responsibility to triage out our resource of self as fairly and efficiently as possible.

But here’s the other thing I probably didn’t see back then. I am quite certain that nurse cared for my mother. Cared, as in had great concern for her welfare as a human being. From my experience, nursing is a chaotic, challenging, and frequently a poorly compensated profession. So if a nurse is there it’s because they have a heart for the vocation. Their patients are their purpose, and even if it may not appear that way, they care.

I’ve recently gone PRN which means even less time at the bedside for me. It’s been so nice to focus my time at home with my children, but I still do enjoy the field of Nursing. It’s something God led me to pursue twenty years ago, and my heart still bursts with joy and pride over the field despite how it may have changed over the years or any difficulties inherent with the vocation. I love nursing, but nursing is hard. It just is. Many days, especially as I’ve stepped back from being in the thick of it as much, I feel ill-equipped to face the task in front of me. Technology changes, patients keep getting sicker, we get even better at keeping them going, and I end up walking into a patient assignment that is almost overwhelming to me.

I recently accepted just an assignment, and as I traced all the many IV medication lines and varying monitoring wires mixed with multiple tubes exiting the patient’s body I was reminded of that old saying about not being able to see the forest for the trees. In the end, no matter how many IV meds are there to titrate, or how many numbers constantly change on multiple monitor screens, you have to remember there’s a patient in the bed. If he’s got airway, breathing, and circulation you can always work outwards from that. Yet despite that simple truth, many times when I find myself in the midst of a critical care situation I feel a bit lacking. I just do.

What do you do when God has given you a calling, but your confidence doesn’t match it? How do you proceed when you feel like your abilities aren’t enough for the situation at hand? What about when it’s too busy, and you fear that you are missing something vital? Or maybe you just worry about messing up period. I mean, let’s be honest here. Life and death is kind of a big deal, and when your actions can make the difference in the two that can be a bit overwhelming to say the least. So sometimes when I’m given that really critical patient I may wonder, do I really have what it takes to care for this patient like they deserve?

Every morning before I go into work at the bedside I will pray. I pray many things. For one, I always pray to hear God’s voice, and over the years that has proven most effective. There’s nothing quite like that gut feeling that warns you of emanate doom, or that small still voice that directs you in your care. It’s in that medium that I work best, and it reminds me of the spiritual truth that carries me when I do not feel like I can carry myself.

Philippians 4:13

I can do all this through him who gives me strength.

When the Lord has called you to something that you feel is greater than yourself He will equip you to complete it. Much like Moses feeling inadequate to lead the Israelites out of Egypt, sometimes I feel inadequate to care for my patients. After thirteen years in critical care I guess I’m still my own worst enemy, but I am reminded that the Lord places within me the strength, knowledge, and ability to perform the work He has given me to do at this time. I just have to walk confidently in that.

So I transversed confidently through all the tubes, wires, lines, pumps, monitors, readings, and alarms. Then when my severely, critically-ill patient held his own, and my routine post-op patient took an expected turn for the worse, I would like to think I handled it with the precision and care that was deserved. When I hopped on the bed and started cranking out chest compressions I’d like to believe that each one delivered just the right amount of oxygenated blood that was required until her heart started beating again later on its own. Hallelujah.

After the day was done and I had one critically ill patient on the road to recovery, and another that had tried to die back to stable, I felt like I had done good. My coworkers and the doctors said I had, which helped.

I remember joking to a fellow nurse that day, “nursing is hard, yo!”

To which we all chuckled. But it was true. I think, for me, sometimes the hardest part is believing I have all that it takes to do the job as well as I desire to do it. Honestly, sometimes I wonder, but it’s always the calming spirit of the Lord that reminds me what I can do when He is for me. I truly believe that when God gives you a calling for the field of Nursing He will also equip you with the critical thinking to do more than you can imagine that you are capable of doing. So even in those moments where it may seem like more than you can handle, you do just fine. You actually do very well.

I was thinking this morning about my different blog topics that I often cover. I haven’t written on the topic of nursing in some time, and I regret that for my nursing friends. I have felt a bit stifled by the strong opinions of others, and I had to take some time to assess where I stood in my feelings of the nursing field. I was teetering on the edge of burnout which caused me much distress because of how much I love the field. Regardless, this morning I thought of how well my nursing blogs are received. Even to this day I have nursing posts written three years ago that still go viral, and while that surprises me, it also is kind of expected. After all, I realize that nurses need a voice. Just like all the mommy blogs, nurses need to feel they’re not alone. They need to laugh, but most of all they need to be encouraged. And here’s why.

Have you ever held a job where you’re responsible for another person’s life?

That’s why nurses need encouragement.

Have you ever held a position where if you made a mistake (something that’s easy to do) someone could die?

That’s why nurses need encouragement.

Have you ever worked in an environment where you’re yelled at for things outside of your control?

That’s why nurses need encouragement.

Have you ever been treated horribly in the workplace not because of your performance, per se, but simply because the circumstances of being sick are awful? What I mean is, have you endured the brunt of someone’s frustration even when it has nothing to do with you personally?

That’s why nurses need encouragement.

Have you ever tried to memorize a million different medications, dosages, and side effects to perform your job safely?

That’s why nurses need encouragement.

Have you ever worked short-staffed? You probably have. But did it create an unsafe environment where you feared mortal consequences could result?

That’s why nurses need encouragement.

Have you ever been talked down to by someone above your pay grade? Probably so. What about when they’re 10-20 years younger than you with a decade less experience in the field? What if this was your norm?

That’s why nurses need encouragement.

Do you face death and dying on a regular basis?

That’s why nurses need encouragement.

Have you ever cried in empathy for someone’s death you didn’t know?

That’s why nurses need encouragement.

Do you build a protective wall around your emotions as a coping mechanism to be able to continue doing your job?

That’s why nurses need encouragement.

Have you ever educated someone on lifesaving information that they continue to ignore, and watch them enter your workplace over and over due to their noncompliance?

That’s why nurses need encouragement.

Do you ever get yelled at for not answering someone’s call quick enough for a straw, even though you were distracted by saving a life?

That’s why nurses need encouragement.

Have you ever broken someone’s ribs trying to save them?

That’s why nurses need encouragement.

Have you ever had someone beg you to let them die? Or to kill them so they can escape the pain?

That’s why nurses need encouragement.

Have you ever watched the same individual try and kill themselves mulitple times? But then one day you don’t see them anymore?

That’s why nurses need encouragement.

Have you ever been cussed out, spit on, and punched for trying to help someone?

That’s why nurses need encouragement.

Do you go home covered in a stranger’s body fluids?

That’s why nurses need encouragement.

Have you ever lifted more weight at work than you know is safe because otherwise someone under your care would have been hurt?

That’s why nurses need encouragement.

Have you ever hurt your back at work?

That’s why nurses need encouragement.

Do you take care of addicts, criminals, or hateful individuals, but treat them all like gold?

That’s why nurses need encouragement.

Are you expected to leave your personal problems at home, rid yourself of preconceived notions, and accept harsh treatment with a smile?

That’s why nurses need encouragement.

Do you encounter contagious, deadly diseases in your workspace?

That’s why nurses need encouragement.

Does your job commonly hold unrealistic expectations by the public?

That’s why nurses need encouragement.

Do you work a shift that exceeds twelve hours, sometimes is twenty four hours, and you cannot leave under penalty of law until you’re relieved?

That’s why nurses need encouragement.

Do you have to show up at work regardless of the weather, it being a weekend, holiday, or middle of the night?

That’s why nurses need encouragement.

Do you suffer from the stress of your work responsibility, the hectic, uncertain pace, and fear of making an error that could result in a lawsuit?

That’s why nurses need encouragement.

Do you cry at the end of the workday?
That’s why nurses need encouragement.

Do you spend an enormous amount of time on continuing education, training on ever-changing technology, licensing requirements, and mandatory meetings with information that could have been delivered via email?

That’s why nurses need encouragement.

Do you absolutely love what you do, but some days (like the bad days) hate it?

That’s why nurses need encouragement.

If you answered yes to the majority or all of these questions you’re probably a nurse, and hopefully understanding you’re not alone in these circumstances encourages you.

I am ashamed to say that I stood in the shower recently before work and other than offering up the usual prayers for a smooth day I actually made a very specific petition for divine intervention. The day before I had helped a coworker with a very unstable patient. I had watched him run his legs off trying to keep this patient alive, and I just wasn’t up for taking the reigns on that one in his absence. I was tired, and the thought of the serious mental concentration that would be required to combat the patient’s labile blood pressure and respiratory distress for thirteen hours wasn’t something that made me want to turn cartwheels. In fact, I wanted no part of it this particular day.
I work in critical care so I’m used to critically ill patients, and yes, that’s just part of it. But I think any nurse will tell you that some days your brain just wants a breather. The thing is we don’t talk about it out loud that much, but the profession we have chosen comes with a mountain of responsibility. Yes, it comes with loads of rewards, but it’s also a bit frightening when you think about it. So typically we don’t. We just do our thing. It’s our job, right? But what exactly does that entail?

Let me tell you a story. I remember once having a patient on the ventilator. He was receiving a large fluid bolus, and though I was close by things happened pretty quickly. I looked up from my seat outside his window and noted the oxygen monitor on his finger suddenly not picking up properly. When I entered the darkened room I was confronted with a huge purple hand. His circulation was compromised and I couldn’t feel or even doppler a pulse. A nearby physican even got excited when I called him to the bedside, and he started contacting the orthopedic doctor on call. It looked like Compartment Syndrome and perhaps a surgical intervention was going to be necessary to save this patient’s limb. Intubated patients can’t tell you it hurts. I wondered was it broken, or just an infiltration gone bad, and should I have caught this sooner?

It happened so quickly, and the crazy thing was that for critical care this patient was incredibly stable. Everything was smooth sailing, but all it took was a moment for things to turn south. The patient was fairly young, and all I kept thinking was, this guy may lose his hand, and it will be my fault.

That’s the truth about nursing that most of us don’t talk about. We don’t talk about it because if we did it might frighten us from the bedside altogether. Simple things, the tasks we take for granted as being second nature, those small things are even big things. A simple med pass can end in a serious allergic reaction, or God-forbid, a deadly medication error. A walk in the hall can become a sentinel event if nonskid socks aren’t worn, or something as easy to do as forgetting to put the call light within reach can lead to a head injury. The everyday nursing task of giving IV fluids can turn into an amputation.

For my patient that day the problem resolved as quickly as it had occurred. After the fluids were stopped, IV removed, and the arm elevated the circulation was restored. No tissue damage incurred, and what could have been a terrible occurrence never resulted in more than a mild, visible swelling by the end of my shift. But it was a reminder of the truth. As a nurse you can never let your guard down for even a moment.

I think of all the shifts over the years where I skipped lunch. Not because I wasn’t hungry; I was, but because I just didn’t feel like I could leave my patient’s side. It didn’t feel safe. There’s not always someone to watch your patient assignment for you. They have their own.

The truth of nursing is that it’s more than just a job. When you walk into the room and accept your assignment you are accepting responsibility for another person’s life. Sure, you’re not a man on an island with no help in sight, but as your patient, the person in the bed is your ultimate responsibility. So if you’re not feeling well, tired from being up with a teething baby, or distracted by personal problems at home, it doesn’t matter. Your responsibility is the same despite your capabilities that day. There becomes no such thing as simple oversight when life and death are on the line. Not being melodramatic. Just keeping it real.

Your mind must work on overtime, thinking not just of the task at hand, but anticipating unforeseen complications or possible outcomes of the intervention you’re considering performing. In critical or emergent situations your mind is not allowed to stop thinking this way. It must continue thinking through every possible scenario and snafu until it’s relieved by another fresh mind half a day later. Whew.

Some days all your patients are golden. Everything runs smoothly and patient presentation is practically perfect in every way. On those days it seems like your job is pretty easy, except for the fact that you always know deep down. You know that you can never fully relax or let down your guard because it could change in a second. It only takes a moment for a heart to stop beating.

So the weight of that responsibility can be pretty heavy some days. The truth can be taxing, and maybe you want a break for your brain. To my fellow nurses I would say, there’s nothing wrong with that. Sometimes it’s okay to speak the truth. It’s a relief even.

It was a day just like any other day, but that’s the thing about nursing; you just never know. What starts as a slow day can turn into a chaotic one, what appears to be a stable patient can quickly take a turn for the worse, and what patient lands in your once empty hospital bed, you can just never tell. On this particular day it was pretty smooth sailing, up until the call came in that is.

In my particular intensive care unit we receive trauma cases, emergency surgeries, and also acute MI (myocardial infarction, aka, heart attack) patients, to name just a few. I’ve been known to say that it’s like Forrest Gump’s box of chocolates. You never know what you’re going to get. But on this particular day the phone call from the care coordinator did clue us in that it would be a STEMI. For the layman, that means emergency. That means big bad heart attack. That means no life-giving oxygen to the heart muscle. It means heart muscle death. It means nursing be on your toes.
On this particular day the presentation of a tombstone shape on the patient’s EKG was a sad foretelling of what the future held, and she actually had already died twice before even making it to our bed. We had participated in the calls of Code Blue and knew what we were in for if and when she eventually made it to her room, but we waited on pins and needles nonetheless. We stood like sentinels at the ready, gloved hands clasped in anticipation of action.

As imagined once she arrived we never stopped. Like liquid action we flowed around the bed attaching monitors, adding even more life-saving medication drips, and the gears in our heads constantly turning for what more we could do to turn this one around. The blood pressure continued to fall, the heart rate continued to become more erratic, and the options began to run out. This becomes a difficult time for everyone. For the nurse who simply wants to cause no harm and save a life. For the physician who wishes they could have done more. And for the family who must make the decisions no one ever imagined they would have to make.

On this particular day they decided to let mom go, and we all held our heads low wishing we had the adequate words of sympathy and consolation. I had not seen this woman’s face without tubes jutting from it, not until after the life in her had ceased, and that often times makes it hard to see the beauty of the person who ends up in your hospital bed. Sadly in those emergent moments you only treat the monstrous disease process, and it isn’t until afterwards that you take the time to think about exactly who you’re treating. A mom. A sister. A wife. A friend. Just a few weeks prior I had cried at the end of an unsuccessful code when I looked at the woman’s face and pictured her son who had visited just the hour before.

Most of the time in situations like this you actually never know the story of the person who briefly occupied your hospital bed, but in this case I did. She wasn’t just a number, and she was certainly more than some easily forgotten name. The legacy she left behind was the stuff statues are erected about, and as I discovered the kind, caring life of service she had lived for others, without any payment in return, I was humbled to the point of tears. The fact that I had been given the privilege to attend to this unsung hero in her last moments made me proud to live the life of a bedside nurse. I had not saved her, but I had tried, and when they said to let go I had done so with her dignity intact. At least I like to think so. I hope so.

After reading her personal story it brought to mind that we never really have a clue who will end up in our hospital bed. We don’t know if they are amazing servants of mankind who will have their own special crown in Heaven. We don’t know if they have been hurt and beat down so severely by the world that they will also earn their own special crown in the hereafter. We never know the story, but we treat them all the same. Each is given that extra measure of care as if they are already wearing a crown. Or at least I like to think so. I hope so.

Sometimes in nursing it’s easy to get bogged down by the excessive workload, the stress of saving lives, or the annoying bureaucracy of the healthcare machine. It’s easy to put up such a protective wall around your heart that you forget the heart is the center of our care. It’s easy to just see a “patient” and not see their story. It’s easy to forget what a privilege it is to serve and sometimes save someone’s mother, father, husband, or child. We should try to always remember that everyone leaves a legacy of some sort behind, that everyone is special in their own right. And because we care for them in those intimate moments we have a very special job indeed.

I’ve written on this subject before, but like many important subjects it needs to be repeated regularly so that everyone gets the memo. I love being a nurse, and even more so, I love that my friends and family love that I’m a nurse. It makes me feel so special when they reach out to me for advice. I’m being honest, it does. It fills me with a particular pride that people seek out my counsel on sensitive, medical subject matter, but there are instances where I wish I could convey a few, simple things. So here’s three things your nurse friend wishes you knew.

1. I don’t know everything. Listen, I’ll be the first person to pat myself on the back at how smart I am, but I have my limitations. I did go to nursing school, which is super hard. And I did learn a ton of stuff. In fact, I’m still learning stuff. But… I don’t know everything.

If you send me a blurry photo of some vague bumps on your toddler’s back I may not be able to throw a diagnosis out to you. In fact, it’s kinda wrong for me to do so. It’s actually outside of my scope of practice to “diagnose.” I will give you my best-educated hypothesis as your friend and as a fellow mom, based on my knowledge and experience, but please understand if I simply don’t know or feel uncomfortable.

When you throw out half a dozen symptoms that point to over a dozen illnesses, again I may be at a loss. I can have an idea based on your presentation, but realize it’s just an idea. It’s not an answer written in stone. That’s why there are things like health history and lab tests that are used to diagnose you.

I also don’t know the name, dosage, and side effects of every drug on the market today. Seriously, have you watched TV lately? There’s like a billion. I’m going to tell you a secret right now. When you ask me a question about a new medicine you’ve been prescribed, nine times out of ten I Google it. I’m a really good googler.

So, you can keep asking me questions. I really don’t mind. Just remember, I don’t know everything. Just most of everything. 2. My advice doesn’t replace that of a physician. I wish I had a dollar for every time someone has asked me for advice to prevent going to the ER. Heck, keep asking me. I have friends who work in the ER and I know they appreciate me telling you to not go there. It’s actually pretty easy. 90% of the time if you can take a moment to text me about it and you have reservations about it being ER worthy then it most likely is not. Typically an emergency room visit is an emergency and you won’t have time to phone a friend. Most instances can be more appropriately seen in an acute care clinic setting. There are so many of those open nowadays.

But, most importantly, please know this. My advice is just that. Friendly advice. It should not take the absolute place of a doctor’s visit. If you think you need to go to the ER, go. If you need to get a cure for what’s ailing you then hop in the car and bite the bullet on your copay at the doctor’s office.

As your friend I will gladly suggest home remedies and over the counter medications you can take to help you. As your friend I love to help you. But as a nurse my opinion should not replace that of your physician. I just happen to be your friend or family member who is also a nurse. Go to the doctor already, Dad! I love you.

3. I cannot explain or be held accountable for how your healthcare experience goes. I’m a nurse. Yes, this is true. But I cannot explain why your nurse at your last hospital visit did things a certain way. I can’t explain why the cardiologist’s office won’t call you back. I can’t explain why your family doctor prescribed a second pill for your blood pressure. He has his reasons. I don’t know why that nurse was rude or that doctor incompetent. I wasn’t there. My position in the healthcare field does not somehow mentally connect me to all the other members of the field out there. It doesn’t make your healthcare experience any easier just because you know this nurse (me) who said ____, and I promise if you tell them I did they’ll likely roll their eyes at you. Sorry, but true.

I’m a nurse, and I’m your friend, but I have little to zero control over how your healthcare experience goes unless I am directly related in delivering your care. Again, I don’t know all the answers, and even if I knew most I couldn’t explain why it takes so long in the waiting room of the ER. (But I might guess it has something to do with what we talked about in #2).

Bottom line, I love being a nurse, and even more so I love being your friend who happens to be a nurse. I don’t know everything, but I’ll help you in any way I can. I won’t always have all the answers, and I do have my limitations, but don’t stop asking; I really do love to help. But you gotta stop asking questions that violate the HIPAA privacy laws. I really can’t go there.

Midway through my nursing career I took a break from the chaos of critical care to try a different area in the healthcare field. To many people’s surprise, a month after my own mother’s sudden passing I took a position as a Hospice Nurse.

For those of you unfamiliar with the term, Hospice is a form of palliative, or rather end-of-life care. When an individual has come to a place in their chronic disease process where no amount of medical intervention can reverse the outcome of their illness, they may decide to take the course of hospice care.

Hospice/palliative care doesn’t mean you’re giving up on life. No, it means you wish to live the remainder of your time on earth with dignity, savoring your life and living it as you wish. You decide to forgo painful medical interventions that will have no positive long-term effect on your illness.

Hospice turned out to be so much more than I ever thought it was, and to this day it is still one of my favorite areas I have worked in. I learned a few things in my years as a hospice nurse, and I also realized I had plenty to keep me busy.

It turns out that patients who had a chronic condition, that would sooner rather than later take their life, still had many of the same needs an acutely ill patient possessed. They still experienced painful urinary tract infections that could be treated easily, or fluid on their lungs that might be lessened by a dose of diuretic. So even though they were in essence dying, for the time I cared for them they were still alive, and as such deserved my full attention and care.

My first month on the job I discovered some physicians less than eager to provide me with the necessities for these patients. I’m not sure if they expected that once they signed off on Hospice orders for a patient that their job was done, or if they just didn’t feel it was important to treat a person who was gonna die soon anyway.

It turns out some doctors and nurses get Hospice, and some do not. When I returned to the intensive care bedside I realized the same held true. It’s a difficult situation to make a patient a DNR (do not resuscitate), but becomes even more difficult if everyone involved doesn’t understand what this may entail.

DNR does not mean “do not treat.”

A Hospice patient may enter the hospital for treatment of an acute condition not related to their chronic condition for which they receive end-of-life care.

If you had a painful fracture would you want it treated?

If breathing was difficult for you would you like some oxygen?

If running a high fever caused uncomfortable tremors wouldn’t you want that fever treated?

If a little Lasix could lessen the feeling of drowning in your own secretions or painfully tight edema, wouldn’t it be worth administering?

If turning and positioning will prevent painful bedsores, then why not?

In the end the decision to treat a chronically ill patient is determined per the patient’s wishes, or in lieu of their orientation and ability to verbalize, a family member’s consent. But as a patient’s health care advocate we must all widen our focus when it comes to palliative care.

Treatment of a patient who is a DNR is not black and white, and each decision to treat should be based on the best outcome for the patient. Despite a patient’s eventual passing, they still deserve treatment in their best interest.

Pain should not occur, period. And any acute condition that could be treated effectively should be done so regardless of the patient’s chronic condition. Unless treatment will cause more pain or discomfort, it should at least be offered, and certainly not withheld.

Whether a patient is expected to live a day or fifty more years, they have one big thing in common. They are human beings who deserve appropriate care and have the right to dignity and respect during that care. How we provide that care will be altered in respect to a patient’s disease process and likely outcome, but care should be provided no matter what.

A good rule of thumb is to picture a patient as your own personal family member. What would you do, how would you proceed?

DNR, Hospice Care, and Palliative Care are all wonderful things in my opinion. They allow a patient and their family the freedom to pursue life on their own terms, with dignity and autonomy. Despite any decision on their part to stop interventions that will have no longstanding effect on their eminent death, we must always be available to provide the care that they do need to make their remaining time easier.

Meet Brie

Brie is a thirty-something (sliding ever closer to forty-something) wife and mother. When she's not loving on her hubby, bouncing a happy toddler on her hip, chasing her preschooler, or teaching her six year old at the kitchen table, she enjoys cooking, reading, and writing down her thoughts to share with others. But honestly she loves nothing more than watching a great movie, or a hot bath, alone if the children allow. Which never happens.Read More…

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